Within living memory, smallpox was a dreaded disease. Over human history it has killed untold millions. In the eighteenth century, as epidemics swept Europe, the first rumors emerged of an effective treatment: a mysterious method called inoculation.

But a key problem remained: convincing people to accept the preventative remedy, the forerunner of vaccination. Arguments raged over risks and benefits, and public resistance ran high. As smallpox ravaged her empire and threatened her court, Catherine the Great took the momentous decision to summon the Quaker physician Thomas Dimsdale from Hertford to St Petersburg to carry out a secret mission that would transform both their lives.

Excerpt

At nine o’clock on a chill evening in October 1768, a carriage arrived at the gates of Wolff House, on the outskirts of St Petersburg, with an urgent summons. Aft er weeks of secret preparations, the call had come at last from the Winter Palace, where the Empress Catherine II waited impatiently for her English doctor, Thomas Dimsdale.

Prepared but uneasy at the task ahead, Thomas climbed quickly into the coach with his son Nathaniel, a medical student. Nathaniel carried a sleeping child, a six-year-old boy named Alexander, small for his age and swaddled in a fur against the autumn cold and the beginnings of a fever.

Leaving the guarded gates of Wolff House, a merchant’s summer residence requisitioned as an isolation hospital, the trio sped through lanes lit by an almost full moon towards the river a short distance to the south. The wide, grey waters of the Neva were not yet frozen, and the coach crossed over a pontoon bridge, then made its way to the rear of the Winter Palace, away from the bustle of the embankment. Drawing up as agreed at a gate close to the grand facades of Millionnaya Street, the two doctors and the boy were ushered quickly up a back staircase. At the top waited Baron Alexander Cherkasov, the Cambridge-educated President of the St Petersburg Medical College, who would act as interpreter.

As they hurried through richly decorated passages to the appointed room, Thomas had reason for trepidation. Over decades of experience, the 56-year-old physician had refined the practice of smallpox inoculation: deliberately infecting patients with a small, controlled dose of the deadly virus itself to give them future immunity against the brutal disease. His landmark treatise explaining his methods, published just a year previously in 1767, was already in its fourth edition, its influence stretching across Europe and confirming England’s place as the global centre of expertise for the preventative treatment.

Yet, despite his flawless record of thousands of successful inoculations, from wealthy aristocrats paying handsome sums to the poorest foundlings he immunised for free, Thomas knew the stakes were now at their highest. Not only did his own reputation hang in the balance, so too did that of the medical procedure he firmly believed could counter one of the greatest threats to human health ever known. If disaster struck – and his Russian test cases at Wolff House had produced disturbingly erratic results – the name of science itself would be tainted, to the benefit of prejudice and superstition.

And if the fear for his profession was not enough, there was his safety and the impact on his country to consider. Back in Britain, King George III himself was following his progress, while diplomats in London and St Petersburg exchanged anxious updates and wished the whole politically hazardous affair swiftly over. In the English market town of Hertford, the family he had reluctantly left almost three months before prayed for his safe return. For Thomas, the danger was only underlined by the Empress’s promise – should things go wrong – of a carriage waiting to spirit him to the safety of a yacht anchored in the Gulf of Finland ready to sail for England. Her death at the hands of a foreigner would spark immediate vengeance: he had witnessed the sparkle of the Russian Court but also the dark brutality of life outside it. If he failed to escape immediately, he expected to pay with his life.

All this preoccupied the mind of the Quaker doctor as he entered the small chamber where Her Imperial Majesty, the Empress Catherine II, waited alone, her mind settled and her countenance perfectly composed. Marvelling at her resolution, Thomas took out a mother-of-pearl and silver case no bigger than his palm and opened the hinged lid to reveal three pearl-handled blades slotted inside. Extracting one, he knelt beside the half-awake Alexander, exposing the boy’s arm to find the place he had inoculated him a few days previously. With the lancet, he pierced the blister, transferring a drop of the infected matter within on to the blade. The Empress pushed back her brocaded sleeves, and the Doctor made the smallest of punctures in her pale skin, one in each upper arm, guiding a drop of the fluid into each incision.

In barely the time needed to throw a set of dice, the procedure was over. The Empress of Russia had been deliberately, and willingly, inoculated with smallpox: the ancient and terrible disease that had killed an estimated sixty million over centuries and disfigured and blinded countless more. Thomas’s record was impeccable, but every jab of the blade carried risk. Now, as Catherine retired to bed and the doctors and the boy stepped back into the cold St Petersburg night, there was nothing to do but wait.

Early in the morning aft er the secret appointment at the Winter Palace, Catherine travelled by carriage to Tsarskoe Selo, an elegant royal estate some twenty miles south of St Petersburg. There, wrapped up against the cold, she walked in landscaped parkland that stands barely changed today, pacing the tree-lined paths as late leaves scattered and were swept away. She dined simply that day on weak soup, boiled chicken and vegetables, sleeping for almost an hour afterwards and waking refreshed.

The Empress’s mood, her doctor noted, was ‘easy and cheerful’, but during the night pain would build around the two incisions on her arms, her joints would begin to ache, and giddiness and fever would strike the following evening. The smallpox virus, one of the most virulent ever known, had entered her bloodstream and, as her body prepared to resist, there was no turning back.

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About the Author

Lucy Ward is a writer and former journalist for the Guardian and Independent. As a Westminster Lobby correspondent, she campaigned for greater women’s representation. From 2010–12, she lived with her family in Moscow, renewing her interest in Russian history. After growing up in Manchester, she studied Early and Middle English at Balliol College, Oxford. She now lives in Essex